Early Stage Identification and Engagement to Reduce the Duration of Untreated Psychosis: Evaluating the Impact of Screening and Systematic Communication

项目摘要/摘要 研究发现，精神病的发病和首次专科治疗的开始之间有很大的延迟 发作性精神病(FEP)，在美国，未经治疗的精神病(DUP)的持续时间通常超过一年。 需要更好的战略来改进对FEP患者的识别，并迅速让他们参与到 旨在恢复功能的协调专科护理(CSC)。这项研究将调查美国是否有 采用荷兰的一种成功的检测方法，并通过创新的模式加以加强 向患者和家属传达有关精神病和治疗选择的信息(Comemoch)，可以 降低DUP。我们在荷兰的合作者比较了连续一次寻求帮助的筛查 进入精神卫生服务的人群从精神卫生诊所转诊到临床医生，并发现 筛查发现了更多患有精神病(CHR)和FEP的临床高危人群。基座 关于荷兰模式，在纽约的西奈山医疗系统内，我们试行并建立了 对进入精神卫生服务的求助青年进行筛查的可行性，以期及早改善 识别FEP病例并迅速转诊至专科护理(早期识别和参与 减少DUP研究(EASE)，由NIMH R34支持)。进入服务的个人将通过 前驱问卷-简版(PQ-B)。筛查呈阳性的人将接受结构化评估 面谈精神病风险综合征(SIPS)并转诊至特定阶段的专科护理(FEP或CHR 服务)。为了促进服务参与，我们开发、试行并确定了ComSquch的可行性 模特。而我们的数据显示，与临床医生转诊相比，系统筛查方法(SM)可以 通过在病程中更早地识别更多的患者、更多 需要进行研究来评估ComSquch对FEP治疗启动和有序参与的影响 以进一步降低DUP。我们将使用阶梯楔形整群随机对照试验设计来比较 对SM的系统筛选和沟通方法(SCM)。在SM的6个月基准期之后， 12家精神卫生诊所将被随机安排(每次2家)，在6个月内从SM过渡到SCM 间隔时间。在这两种情况下，12-30岁的PQ-B筛查呈阳性的人将接受sips评估 由每个诊所的训练有素的临床医生提供，并酌情转介FEP和CHR服务。在SCM条件下 将使用ComSquch模型来促进CHR和FEP服务的启动。我们将针对以下方面衡量DUP 符合精神病标准的患者。我们假设：(1)供应链管理将导致更多的个体数量 与SM相比，启动CHR和FEP服务；(2)在SCM条件下，FEP个体的平均DUP将 低于SM状态下FEP个体的平均DUP，这是由于启动FEP的时间缩短 服务。我们还将审查多层面的实施因素，以确定 未来在日常实践中部署供应链管理的实施策略。

PROJECT SUMMARY/ABSTRACT Studies find a substantial delay between the onset of psychosis and the initiation of specialty treatment for first episode psychosis (FEP), with the duration of untreated psychosis (DUP) typically over one year in the U.S. Better strategies are needed to improve identification of individuals with FEP and to rapidly engage them in Coordinated Specialty Care (CSC) aimed at restoring functioning. This study will investigate whether a U.S. adaptation of a successful detection approach from the Netherlands enhanced by an innovative model of communicating information about psychosis and treatment options to patients and families (ComPsych), can reduce DUP. Our collaborators in the Netherlands compared screening of a consecutive help-seeking population entering mental health services to clinician referral from mental health clinics and found that screening captured significantly more individuals at clinical high risk for psychosis (CHR) and with FEP. Based on the Dutch model, within the Mount Sinai Health System in New York, we have piloted and established the feasibility of screening help-seeking youth entering mental health services with the aim of improving early identification of FEP cases and rapid referral to specialty care (Early Stage Identification and Engagement to Reduce DUP study (EaSIE), supported by NIMH R34). Individuals entering services are screened with the Prodromal Questionnaire-Brief Version (PQ-B). Those who screen positive are assessed by Structured Interview for Psychosis Risk Syndromes (SIPS) and referred to stage-specific specialty care (FEP or CHR services). To facilitate service engagement we developed, piloted, and established feasibility of the ComPsych model. While our data showed that compared to clinician referral, systematic screening method (SM) can substantially reduce DUP by identifying a greater number of patients earlier in the course of illness, more research is needed to evaluate the impact of ComPsych on FEP treatment initiation and engagement in order to further reduce DUP. We will use a stepped-wedge cluster randomized controlled trial design to compare a systematic screening and communication method (SCM) to SM. Following a 6-month baseline period of SM, 12 mental health clinics will be randomized (2 clinics at a time) to transition from SM to SCM at 6-month intervals. In both conditions, individuals aged 12-30 who screen positive on PQ-B will be assessed with SIPS by trained clinicians in each clinic and referred to FEP and CHR services as appropriate. In SCM condition the ComPsych model will be used to facilitate initiation of CHR and FEP services. We will measure DUP for patients who meet psychosis criteria. We hypothesize that: (1) SCM will result in a higher number of individuals initiating CHR and FEP services compared to SM; (2) The mean DUP of FEP individuals in SCM condition will be lower than the mean DUP of FEP individuals in SM condition, due to the reduced time to initiate FEP services. We will also examine multi-level implementation factors that can inform the identification of implementation strategies for future deployment of SCM in routine practice.